Delirium in Palliative Care: Evidence and Practice

Delirium is a frequent condition in Palliative Care. For patients, their families and the formal caregivers it is associated with substantial burden, fears and challenges. It is also associated with increased morbidity and mortality and often irreversible. Of utmost importance is the identification of patients and threat for delirium and prophylactic measures to avoid delirium whenever possible. For this, risk factors should be identified and eliminated whenever possible. The correct identification of delirium is challenging and especially the hypoactive form of delirium is often unrecognised. When delirium is diagnosed, the etiology must be explored thoroughly and potentially reversible causes should be treated and eliminated whenever feasible and appropriate. The pharmacologic therapy is based on benzodiazepines and neuroleptics. Yet, the use of the substances should be restricted to severe psychotic episodes of the hyperactive form of delirium. It is of utmost importance to know that "disorientation", "restlessness" or delirium alone are no indication for pharmacotherapy. Recently two landmark randomized controlled clinical trials concerning pharmacotherapy for delirium in palliative care have been published. This review presents a practical overview of the prevention, diagnosis and therapy of delirium in palliative care along-side the presentation and discussion of the recently published trials.